Heart disease can often have no symptoms, which is why it is called a "silent" killer. But, there are some symptoms that can alert you to a possible problem. Chest or arm discomfort, especially while under stress or during activity, is a classic symptom of heart disease, and is a warning sign of a heart attack. You may also have fatigue (with no reason why), shortness of breath, dizziness, nausea, or abnormal heart beats (palpitations).

Talk with your health care provider if you think you may be having any symptoms of heart disease. Your health care provider will first take a complete medical history and do a physical exam. There are many tests for heart disease. The choice of which (and how many) tests to perform depends on a person's symptoms and history of heart problems. A health care provider will most often start with simple tests, which may lead to tests that are more complex. More than one test may be needed because each test gives different information. Tests can be either invasive or noninvasive. Invasive tests involve the insertion of needles, instruments, or fluids into the body; noninvasive tests do not.

What are the signs of heart attack and stroke?

Know that not everyone gets all of the following warning signs of heart attack or stroke. And, sometimes these signs can go away and return. Treatments are most effective if given within one hour of when the attack begins. If you have any of these symptoms, call 911 right away!

The signs of heart attack include:

• Chest discomfort or uncomfortable pressure, fullness, squeezing, or pain in the center of the chest that lasts longer than a few minutes, or comes and goes.

• Spreading pain to one or both arms, back, jaw, or stomach.

• Cold sweats and nausea.

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to have some of the other warning signs, particularly shortness of breath, nausea, vomiting and back or jaw pain.

The signs of stroke include:

• Sudden numbness or weakness of face, arm, or leg, especially on one side of the body.

• Sudden confusion, or trouble speaking or understanding speech.

• Sudden trouble seeing in one or both eyes.

• Sudden trouble walking, dizziness, or loss of balance or coordination.

• Sudden severe headache with no known cause.

• Blurred or double vision, drowsiness, and nausea or vomiting.

What are palpitations or "extra" heartbeats? Are they dangerous?

"Extra" heartbeats, also called palpitations, or premature ventricular contractions (PVCs) happen when there is irritation in the lower part of the heart's pumping chambers. PVCs interrupt the normal heart rhythm and cause an irregular beat that can feel like a "missed beat" or a "flip-flop" in the chest. This can be harmless or it may lead to problems that are more serious.

If a woman has palpitations and other symptoms such as dizziness or shortness of breath, she should tell her health care provider right away. The health care provider will take a complete medical history and perform a physical exam, and may order further tests to determine the cause of the palpitations. In some people, caffeinated products (coffee, candy bars), alcohol, and stress can cause palpitations. When a woman is in perimenopause (the time before menopause), changing hormone levels can also cause harmless palpitations.

What is an arrhythmia? Can you have a heart arrhythmia without having heart or cardiovascular disease?

Most people have felt their heart beat very fast, felt a fluttering in their chest, or noticed that their heart skipped a beat. Almost everyone has also felt dizzy, faint, or out of breath or had chest pains at one time or another. While these experiences of heart arrhythmias (a change in the regular beat of the heart) can create anxiety, they are, for most people, harmless. As adults age, they are more likely to get arrhythmias. Only a very small number of people have arrhythmias that are dangerous. Don't panic if you have a few flutters or your heart races once in a while. If you have questions about your heart rhythm or symptoms, talk with your health care provider.

Is it safe to take an aspirin a day to prevent heart disease?

If you have already had a heart attack, aspirin helps to lower the risk of having another one. It also helps to keep arteries open in those who have had a heart bypass or other artery-opening procedure such as coronary angioplasty. But, because of its risks, aspirin is NOT approved by the Food and Drug Administration for preventing heart attacks in healthy people. It may even be harmful for some persons, especially those with no risk of heart disease. Talk to your health care provider about whether taking aspirin is right for you. Be sure not to confuse aspirin with other common pain relieving products such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxyn sodium (Aleve).

Do birth control pills and hormone therapy (HT) increase a woman's risk for heart disease?

Birth control pills have little increased risk of heart disease for women who have not gone through menopause (when periods stop). But, they can pose heart disease risks for some women, particularly women with high blood pressure and women who smoke. Talk with your health care provider about whether birth control pills are best for you.

In the past, taking hormone therapy (HT) (estrogen plus progestin) was thought to help protect women against heart disease. But recent findings from the Women's Health Initiative (WHI) study, sponsored by the National Heart, Lung, and Blood Institute, showed that taking HT poses more risks than benefits. The study found that HT could increase a woman's risk for heart disease, stroke, and pulmonary embolism (blood clot in the lung), as well as breast cancer. Because of these findings, the U.S. Preventive Services Task Force recommends that women who have gone through menopause should not be given HT to prevent heart disease and other chronic conditions. The WHI is also looking at the effect of taking estrogen alone (this is given to women who have had a hysterectomy, or no longer have a uterus, or womb) on heart disease and other conditions; results should be available in the next few years, or sooner.

Earlier studies have also shown that women who have gone through menopause and who have heart disease, may have a greater risk of another cardiac event (like heart attack) after starting HT, at least in the short-term. For women who have had strokes, their risk for having another stroke goes up when they start taking HT. Hormones are not recommended for women with heart disease or for women who have had a stroke. If you have gone through menopause, talk with your health care provider about whether hormones are right for you.

If you are taking birth control pills or HT, watch for signs of trouble, such as abnormal bleeding, breast lumps, shortness of breath, dizziness, severe headaches, pain in your calves or chest, and report them to your health care provider right away. Also, talk with your health care provider about how often you should have an exam.

For more information . . .

You can find out more about heart and cardiovascular disease by contacting the National Women's Health Information Center (800-994-9662) or the following organizations:

National Heart, Lung, and Blood Institute (NHLBI)
Phone Number(s): (301) 592-8573
Internet Address: http://www.nhlbi.nih.gov/index.htm